Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain

Abstract Background: Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 +and CD8 +positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain. Methods: Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles. Results: Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls ( p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) ( p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals ( p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group. Conclusion: HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.

Prevalence of bowel symptoms in patients infected with human T-lymphotropic type 1 virus

Abstract INTRODUCTION: Bowel dysfunction is frequent in patients with spinal cord diseases, but little is known about the prevalence of bowel symptoms in human T-lymphotropic virus-(HTLV-1) infected individuals. The purpose of this study is to determine the frequency of bowel symptoms in HTLV-1 infected individuals and their correlation with the degree of neurologic disease. METHODS: This is a cross-sectional study comparing the frequency of bowel symptoms in HTLV-1-infected individuals* and seronegative donors (controls). Patients answered a questionnaire, the Rome III Criteria was applied, and stool consistency was evaluated by the Bristol Stool Form Scale. The individuals were classified as HTLV-1 carriers, probable HTLV-1 myelopathy and definitive HTLV-1 associated myelopathy or tropical spastic paraparesis (definitive HAM / TSP)**. RESULTS: We studied 72 HTLV-1 infected individuals and 72 controls with equal age and gender distribution. Constipation was the most frequent complaint, occurring in 38 % of HTLV-1 individuals and in 15 % of the controls. In comparison to the seronegative controls, the probability of constipation occurrence was approximately 18 times higher in definitive HAM / TSP patients. Straining, lumpy or hard stools, sensation of anorectal obstruction/blockage, fewer than 3 defecations per week, flatulence, soiling, evacuation pain, and bleeding were also more frequent in the HTLV-1 patients than in the controls. Moreover, bowel symptoms were more frequent in patients with definitive or probable HAM / TSP than in carriers. CONCLUSIONS: Bowel symptoms were more frequent in HTLV-1-infected patients than in seronegative controls and the frequency of bowel symptoms correlated with the severity of neurologic disease.

Polymorphism in the interleukin-10 gene is associated with overactive bladder phenotype associated with HTLV-1 infection

Abstract INTRODUCTION Human T-cell lymphotropic virus type 1 (HTLV-1)-associated inflammatory diseases are not well understood; however, their clinical manifestations may be influenced by the host genetic background. METHODS We genotyped 298 individuals with HTLV-1 and 380 controls for interleukin-10 (IL10) gene variants-rs3024496, rs1800871, rs1800896-and used logistic regression analysis to determine their association with clinical phenotypes. RESULTS No association with HTLV-1 infection was observed. However, allele A of rs1800896 (1082bp upstream) was associated with protection against neurological impairment, specifically overactive bladder (OR=0.447, 95% CI 0.28-0.70, p=0.001). CONCLUSIONS Our data suggests that IL10 regulation ameliorates neurological damage in HTLV-1 infections.

The relationship between atopy and neurological manifestations in HTLV-1 infection

Abstract INTRODUCTION: Human T-cell lymphotropic virus type 1 (HTLV-1)induces exaggerated Th1 responses, whereas atopy is associated with exacerbated Th2 responses. METHODS: Here, a cross-sectional study compared the prevalence of atopy in HTLV-1 carriers and HAM/TSP patients. It also compared the spontaneous cytokine production in HTLV-1-infected individuals. A retrospective cohort study evaluated the development of neurological manifestations in atopic and non-atopic carriers. RESULTS: Atopic HAM/TSP patients with high IFN-γ production exhibited higher IL-5 levels than non-atopic patients. Allergic rhinitis accelerated the development of Babinski signals and overactive bladders. CONCLUSIONS: Abnormal Th1 and Th2 responses coexist in HTLV-1-infected individuals and allergic diseases may worsen the clinical course of HTLV-1 infections.

Inflammatory and immunological profiles in patients with COPD: relationship with FEV 1 reversibility / Perfil inflamatório e imunológico em pacientes com DPOC: relação com a reversibilidade do VEF 1

ABSTRACT Objective: To determine whether COPD severity correlates with sputum cell counts, atopy, and asthma. Methods: This was a cross-sectional study involving 37 patients with COPD and 22 healthy subjects with normal lung function (controls). Sputum cell counts were determined by microscopy after centrifugation of samples. Skin prick tests were performed, and serum cytokines were determined by ELISA. Results: Patients were stratified by bronchodilator response: a non-reversible airflow limitation (nonRAL) group comprised 24 patients showing no significant post-bronchodilator change in FEV1; and a partially reversible airflow limitation (partialRAL) group comprised 13 patients showing FEV1 reversibility (post-bronchodilator FEV1 increase ≥ 12%). The proportion of eosinophils in sputum was higher in the partialRAL group than in the nonRAL group (p < 0.01), and there was an inverse correlation between the proportion of eosinophils and FEV1 (p < 0.05). However, none of the patients had a history of asthma and skin prick test results did not differ between the two groups. In the patient sputum samples, neutrophils predominated. Serum levels of TNF, IL-6, IL-8, and RANTES (CCL5) were higher in patients than in controls (p < 0.001) but did not differ between the two patient groups. Conclusions: COPD patients with partial FEV1 reversibility appear to have higher sputum eosinophil counts and greater airway hyperresponsiveness than do those with no FEV1 reversibility. However, we found that COPD severity did not correlate with atopy or with the cytokine profile.

RESUMO Objetivo: Determinar se a gravidade da DPOC se correlaciona com a contagem de células no escarro, atopia e asma. Métodos: Estudo transversal com 37 pacientes com DPOC e 22 indivíduos saudáveis com função pulmonar normal (controles). As contagens de células no escarro foram determinadas por microscopia após a centrifugação das amostras. Foram realizados testes cutâneos de puntura, e as citocinas séricas foram determinadas por ELISA. Resultados: Os pacientes foram estratificados pela resposta ao broncodilatador: o grupo de limitação ao fluxo aéreo não reversível (LFAnr) envolveu 24 pacientes sem alteração significativa do VEF1 pós-broncodilatador, e o grupo de limitação ao fluxo aéreo parcialmente reversível (LFApr) envolveu 13 pacientes com reversibilidade do VEF1 (aumento do VEF1 pós-broncodilatador ≥ 12%). A proporção de eosinófilos no escarro foi maior no grupo LFApr do que no LFAnr (p < 0,01), e houve uma correlação inversa entre a proporção de eosinófilos e VEF1 (p < 0,05). Entretanto, nenhum dos pacientes apresentou histórico de asma e os resultados dos testes cutâneos não diferiram entre os dois grupos. Nas amostras de escarro dos pacientes, os neutrófilos predominaram. Os níveis séricos de TNF, IL-6, IL-8 e RANTES (CCL5) foram maiores nos pacientes que nos controles (p < 0,001), mas não diferiram entre os dois grupos de pacientes. Conclusões: Pacientes com DPOC e reversibilidade parcial do VEF1 parecem apresentar maiores contagens de eosinófilos no escarro e maior hiper-responsividade das vias aéreas que aqueles sem reversibilidade do VEF1. Entretanto, a gravidade da DPOC não se correlacionou com atopia ou perfil das citocinas.

The use of botulinum toxin type A in the treatment of HTLV-1-associated overactive bladder refractory to conventional therapy

Urinary symptoms occur in 19% of human T-cell lymphotropic virus type 1 (HTLV-1)-infected patients who do not fulfill criteria for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and in almost 100% of HAM/TSP patients. Few studies have evaluated therapies for overactive bladder (OAB) caused by HTLV-1 infection. This case report describes the effect of onabotulinum toxin A on the urinary manifestations of three patients with HAM/TSP and OAB symptoms. The patients were intravesically administered 200 units of Botox®. Their incontinence episodes improved, and their OAB symptoms scores (OABSS) reduced significantly. These data indicate that Botox® should be a treatment option for OAB associated with HTLV-1 infection.

Host genetic factors in American cutaneous leishmaniasis: a critical appraisal of studies conducted in an endemic area of Brazil

American cutaneous leishmaniasis (ACL) is a vector-transmitted infectious disease with an estimated 1.5 million new cases per year. In Brazil, ACL represents a significant public health problem, with approximately 30,000 new reported cases annually, representing an incidence of 18.5 cases per 100,000 inhabitants. Corte de Pedra is in a region endemic for ACL in the state of Bahia (BA), northeastern Brazil, with 500-1,300 patients treated annually. Over the last decade, population and family-based candidate gene studies were conducted in Corte de Pedra, founded on previous knowledge from studies on mice and humans. Notwithstanding limitations related to sample size and power, these studies contribute important genetic biomarkers that identify novel pathways of disease pathogenesis and possible new therapeutic targets. The present paper is a narrative review about ACL immunogenetics in BA, highlighting in particular the interacting roles of the wound healing gene FLI1 with interleukin-6 and genes SMAD2 and SMAD3 of the transforming growth factor beta signalling pathway. This research highlights the need for well-powered genetic and functional studies on Leishmania braziliensis infection as essential to define and validate the role of host genes in determining resistance/susceptibility regarding this disease.

Inflammation in disseminated lesions: an analysis of CD4+, CD20+, CD68+, CD31+ and vW+ cells in non-ulcerated lesions of disseminated leishmaniasis

Disseminated leishmaniasis (DL) differs from other clinical forms of the disease due to the presence of many non-ulcerated lesions (papules and nodules) in non-contiguous areas of the body. We describe the histopathology of DL non-ulcerated lesions and the presence of CD4-, CD20-, CD68-, CD31- and von Willebrand factor (vW)-positive cells in the inflamed area. We analysed eighteen biopsies from non-ulcerated lesions and quantified the inflamed areas and the expression of CD4, CD20, CD68, CD31 and vW using Image-Pro software (Media Cybernetics). Diffuse lymphoplasmacytic perivascular infiltrates were found in dermal skin. Inflammation was observed in 3-73% of the total biopsy area and showed a significant linear correlation with the number of vW+ vessels. The most common cells were CD68+ macrophages, CD20+ B-cells and CD4+ T-cells. A significant linear correlation between CD4+ and CD20+ cells and the size of the inflamed area was also found. Our findings show chronic inflammation in all DL non-ulcerated lesions predominantly formed by macrophages, plasmacytes and T and B-cells. As the inflamed area expanded, the number of granulomas and extent of the vascular framework increased. Thus, we demonstrate that vessels may have an important role in the clinical evolution of DL lesions.

Immunopathogenesis and neurological manifestations associated to HTLV-1 infection / Imunopatogênese e manifestações neurológicas associadas à infecção pelo HTLV-1

The human T lymphotropic virus type-1 (HTLV-1) was the first human retrovirus identified. The virus is transmitted through sexual intercourse, blood transfusion, sharing of contaminated needles or syringes and from mother to child, mainly through breastfeeding. In addition to the well-known association between HTLV-1 and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), several diseases and neurologic manifestations have been associated with the virus. This review was conducted through a PubMed search of the terms HTLV-1, immune response and neurological diseases. Emphasis was given to the most recent data regarding pathogenesis and clinical manifestations of HTLV-1 infection. The aim of the review is to analyze the immune response and the variety of neurological manifestations associated to HTLV-1 infection. A total of 102 articles were reviewed. The literature shows that a large percentage of HTLV-1 infected individuals have others neurological symptoms than HAM/TSP. Increased understanding of these numerous others clinical manifestations associated to the virus than adult T cell leukemia/lymphoma (ATLL) and HAM/TSP has challenged the view that HTLV-1 is a low morbidity infection.

O vírus linfotrópico de células T humanas do tipo 1 (HTLV-1) foi o primeiro retrovírus humano identificado. O vírus é transmitido via relação sexual, transfusão de sangue, compartilhamento de agulhas ou seringas contaminadas ou da mãe para o filho, principalmente através da amamentação. Além da conhecida associação entre o HTLV-1 e a mielopatia associada ao HTLV-1 (HAM/TSP), várias doenças e manifestações neurológicas tem sido associadas com o vírus. Esta revisão de literatura foi conduzida através de pesquisa ao banco de dados do PubMed, com os termos HTLV-1, resposta imune e doenças neurológicas. Foram enfatizados os dados mais recentes sobre a patogênese e às manifestações clínicas na infecção pelo HTLV-1. O objetivo dessa revisão é analisar a resposta imune e a variedade de manifestações neurológicas associadas com a infecção pelo HTLV-1. Um total de 102 artigos foi analisado. A literatura mostra que grande porcentagem de indivíduos infectados pelo HTLV-1 apresenta sintomas neurológicos mesmo na ausência de HAM/TSP. Uma maior compreensão das várias manifestações clínicas associadas ao vírus, além da leucemia/linfoma de células T do adulto (ATLL) e HAM/TSP, auxilia a estabelecer que, na realidade, a infecção pelo vírus possui uma morbidade maior do que se pensava.

Schistosoma mansoni antigens alter the cytokine response in vitro during cutaneous leishmaniasis

Schistosoma mansoni infection or associated products are able to down-modulate the type 1 CD4+ T cell inflammatory response characteristic of autoimmune diseases. In this study, we evaluated how S. mansoni antigens altered the immune response that was induced by the soluble Leishmania antigen (SLA) from cutaneous leishmaniasis (CL) patients. Cytokines were measured from the supernatants of peripheral blood mononuclear cell cultures stimulated with SLA. This was performed using the sandwich enzyme linked immunosorbent assay technique in the presence or absence of S. mansoni recombinant antigens Sm29, SmTSP-2 and PIII. The addition of S. mansoni antigens to the cultures resulted in the reduction of interferon gamma (IFN-γ) levels in 37-50 percent of patients. Although to a lesser extent, the antigens were also able to decrease the production of tumour necrosis factor-alpha (TNF-α). We compared patients that either had or did not have reduction in IFN-γ and TNF-α production in cultures stimulated with SLA in the presence of S. mansoni antigens. We found that there was no significant difference in the levels of interleukin (IL)-10 and IL-5 in response to S. mansoni antigens between the groups. The antigens used in this study down-modulated the in vitro proinflammatory response induced by SLA in a group of CL patients through a currently undefined mechanism.

Serum cytokine levels in patients with chronic low back pain due to herniated disc: analytical cross-sectional study / Concentrações plasmáticas de citocinas em pacientes com lombalgia crônica por hérnia de disco: estudo transversal analítico

CONTEXT AND OBJECTIVE: The role of immune response and proinflammatory cytokines in the pathogenesis of chronic pain has been of growing interest. In order to evaluate whether there is any association between disc herniation and elevated cytokine levels, we measured cytokine levels in patients with chronic low back pain and in healthy subjects. DESIGN AND SETTING: Analytical cross-sectional study at the Pain Clinic of Universidade Federal da Bahia (UFBA). METHODS: Cytokine levels were measured using the enzyme-linked immunosorbent assay (ELISA) technique on 23 patients with low back pain (G1) and on 10 healthy subjects (G2). RESULTS: The levels of tumor necrosis factor-alpha [TNF-alpha] (G1 = 5.6 ± 2.3 pg/ml; G2 = 1.6 ± 0.5 pg/ml; P = 0.01) and interleukin-6 [IL-6] (G1 = 4.1 ± 3.0 pg/ml; G2 = 0.9 ± 0.4 pg/ml; P = 0.01) were higher in G1. There were no statistically significant differences in relation to interleukin-1 [IL-1] (G1 = 0.5 ± 0.3 pg/ml; G2 = 0.5 ± 0.1 pg/ml; P = 1) or soluble tumor necrosis factor receptor [sTNF-R] (G1 = 572 pg/ml ± 36; G2 = 581 ± 50 pg/ml; P = 0.87). CONCLUSION: The patients with chronic low back pain due to disc herniation presented higher levels of TNF-alpha and IL-6, but not of IL-1 or sTNF-R.

CONTEXTO E OBJETIVO: A função da resposta imunológica e das citocinas pró-inflamatórias na patogênese da dor crônica tem tido interesse crescente. Para avaliar se há correlação entre hérnia de disco e aumento de citocinas, foi medida a concentração de citocinas em pacientes com lombalgia crônica e em indivíduos sadios. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico realizado na Clínica de Dor da Universidade Federal da Bahia (UFBA). MÉTODO: As concentrações de citocinas foram medidas pela técnica de ELISA (enzyme linked immunosorbent assay) em 23 pacientes com lombalgia (G1) e 10 sadios (G2). RESULTADOS: As concentrações de fator-alfa de necrose tumoral [TNF-alpha] (G1 = 5.6 ± 2.3 pg/ml; G2 = 1.6 ± 0.5 pg/ml; P = 0,01) e interleucina-6 [IL-6] (G1 = 4.1 ± 3.0 pg/ml; G2 = 0.9 ± 0.4 pg/ml; P = 0,01) foram maiores no G1. Não houve diferença estatisticamente significante para interleucina-1 [IL-1] (G1 = 0.5 ± 0.3 pg/ml; G2 = 0.5 ± 0.1 pg/ml; P = 1) e receptor solúvel do factor de necrose tumoral [sTNF-R] (G1 = 572 pg/ml ± 36; G2 = 581 ± 50 pg/ml; P = 0,87). CONCLUSÃO: Os pacientes com lombalgia crônica por hérnia de disco apresentam concentrações maiores de TNF-alpha e IL-6, mas não de IL-1 ou sTNF-R.

Freqüência de doenças reumáticas em indivíduos infectados pelo HTLV-1 / Frequency of rheumatic diseases in individuals infected with HTLV-1

INTRODUÇÃO: o HTLV-1 é um retrovírus humano associado à leucemia de células T do adulto e à mielopatia associada ao HTLV-1 ou paraparesia espástica tropical, que tem sido implicado também no desenvolvimento de auto-imunidade. OBJETIVO: o objetivo deste estudo foi determinar a freqüência de doenças reumáticas auto-imunes em pacientes infectados pelo HTLV-1. PACIENTES E MÉTODOS: foram incluídos nesse estudo 137 indivíduos infectados pelo HTLV-1 atendidos no Ambulatório Multidisciplinar do Serviço de Imunologia do Hospital Universitário Professor Edgard Santos (HUPES) da Universidade Federal da Bahia (UFBA), no período de janeiro de 2003 a maio de 2004. Os pacientes responderam a um questionário geral relacionado a manifestações reumatológicas e questionários específicos para confirmação dos critérios diagnósticos de artrite reumatóide (AR), lúpus eritematoso sistêmico (LES), síndrome de Sjõgren e polimiosite. Adicionalmente, todos eles foram submetidos a exames clínicos específicos e avaliação complementar. RESUTADOS: 24 pacientes tiveram o diagnóstico de síndrome de Sjõgren (SS) provável (17,5 por cento), 18 pacientes (13,1 por cento) de AR, uma paciente teve diagnóstico de LES e uma de doença mista do tecido conjuntivo (0,7 por cento, respectivamente). Suspeita de artropatia relacionada ao vírus foi encontrada em 22 pacientes (16,1 por cento). Síndrome de Sjõgren e AR foram mais freqüentes nos pacientes com mielopatia (33,3 e 25,9 por cento, respectivamente) do que nos portadores assintomáticos (13,6 e 10 por cento, respectivamente). Artropatia relacionada ao HTLV-1 ocorreu com freqüência semelhante em ambos os grupos. CONCLUSÃO: foi observado neste trabalho alta prevalência de síndrome de Sjõgren e de AR entre os indivíduos infectados pelo HTLV-1, principalmente naqueles com mielopatia. Diante desses resultados, que reforçam os dados da literatura, deve-se estar atento para a ocorrência de doenças reumáticas auto-imunes nesses pacientes.

INTRODUCTION: the HTLV-1 is a human retrovirus associated with adult T-cell leukaemia (ATL) and with HTLV-1- associated myelopathy or tropical spastic paraparesis, which has also been implicated in the development of autoimmunity. OBJECTIVE: the aim of this study was to determine the frequency of autoimmune rheumatic diseases in patients infected with HTLV-1. PATIENTS AND METHODS: it was included 137 individuals infected with HTLV-1 from the Multidisciplinary Ambulatory of Immunology Service, HUPES-UFBA, Salvador (BA), from January 2003 to May 2004. All participants answered to a general questionnaire regarding rheumathological manifestations and specific questionnaires to confirm the diagnose criteria of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), SjõgrenÆs syndrome (SS) and polymyositis. Additionally, they were submitted to specific clinical exams, besides complementary evaluations. RESULTS: 24 patients had diagnose of probable SjõgrenÆs syndrome (17.5 percent), 18 patients (13.1 percent) had RA, one patient had diagnose of SLE (0.7 percent) and another of mixed connective tissue disease (0.7 percent, respectively). HTLV-1-associated arthropathy (HAAP) was suspected in 22 individuals (16.1 percent). SjõgrenÆs syndrome and RA were more frequent in patients with myelopathy (33.3 and 25.9 percent, respectively) than in asymptomatic carriers (13.6 and 10 percent, respectively). The frequency of HTLV-1-associated arthropathy was the same in both groups. CONCLUSION: in this study it was observed a high frequency of SjõgrenÆs syndrome and RA in individuals infected with HTLV-1, mainly in those with myelopathy. Therefore, with this results that support data in the literature, we should call attention to the occurrence of autoimmune rheumatic diseases in these kind of patients.

Doenças reumáticas auto-imunes em indivíduos infectados pelo HTLV-1 / Autoimmune rheumatic diseases in HTLV-1 infected individuals

O HTLV-1 foi o primeiro retrovírus humano a ser associado às doenças malignas leucemia e linfoma de células T do adulto (LLTA). Ele está relacionado também a uma doença inflamatória crônica do sistema nervoso central (SNC) conhecida como paraparesia espástica tropical/mielopatia associada ao HTLV-1 (PET/MAH). O HTLV-1 tem sido implicado na patogênese de várias doenças auto-imunes, tais como: diabetes, esclerose múltipla, dermatite infectiva, uveíte e artropatia. Ao longo dos anos, a infecção retroviral tem assumido um importante papel na patogênese das doenças reumáticas auto-imunes. Partículas semelhantes aos retrovírus têm sido identificadas em tecidos de pacientes com artrite reumatóide (AR), síndrome de Sjõgren, lúpus eritematoso sistêmico (LES) e polimiosite. A síndrome de Sjõgren e a AR têm sido as doenças reumáticas mais encontradas nos pacientes infectados pelo HTLV-1, sendo a freqüência mais elevada nos pacientes com mielopatia. A alta prevalência de síndrome de Sjõgren e de AR entre os indivíduos com mielopatia sugere que a carga viral e a resposta inflamatória exacerbada, que concorrem para o desenvolvimento da mielopatia, devem também influenciar no desenvolvimento das doenças reumáticas auto-imunes.

The HTLV-1 was the first human retrovirus associated with adult T-cell leukemia/lymphoma (LLTA). The virus also causes a chronic inflammatory disease of the central nervous system named HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP). HTLV-1 has been implicated in the pathogenesis of many autoimmune diseases, such as diabetes, multiple sclerosis, infective dermatitis, uveitis and arthropathy. It has long been suggested that retroviral infection may play a role in the pathogenesis of autoimmune rheumatic diseases. Particles resembling retroviruses have been reported in tissue from patients with rheumatoid arthritis (RA), Sjõgren's syndrome, systemic lupus erythematosus (SLE) and polymyositis. Sjõgren's syndrome and RA have been the most frequent rheumatic diseases in patients infected with HTLV-1, being more prevalent in patients with myelopathy. The high prevalence of Sjõgren's syndrome and RA in individuals with myelopathy, suggests that the viral burden and exacerbated inflammatory response may play a role not only in the development of myelopathy, but may also influence the outcome of autoimmune rheumatic diseases.

Papel da lidocaína por via venosa no tratamento da dor na esclerodermia: relato de caso / Intravenous lidocaine to treat scleroderma pain: case report

JUSTIFICATIVA E OBJETIVOS: A esclerodermia ou esclerose sistêmica progressiva é uma doença sistêmica do tecido conjuntivo, de causa desconhecida, que costuma cursar com microangiopatia, isquemia de extremidades e dor intensa. O objetivo deste relato é descrever um caso do emprego de lidocaína por via venosa no tratamento da dor no curso de isquemia e enfatizar a possível ação antiinflamatória dos anestésicos locais nos pacientes com esclerodermia. RELATO DO CASO: Paciente do sexo feminino, 34 anos, auxiliar de enfermagem, portadora de esclerodermia há aproximadamente 8 anos, apresentava dor de elevada intensidade (escala numérica =10) nos membros superiores e inferiores, contínua, diária, acompanhada de alterações tróficas, da cor e da temperatura e pequenas úlceras nas extremidades. A paciente foi submetida a uma sessão semanal de lidocaína a 2 por cento (400 mg) sem vasoconstritor por via venosa durante 10 semanas com alívio da dor, do turgor, da elasticidade da pele e da perfusão periférica. CONCLUSÕES: O alívio da dor e de outros sintomas após a administração de lidocaína por via venosa sugere que os anestésicos locais podem modular a resposta inflamatória em vários estágios da esclerodermia

BACKGROUND AND OBJECTIVES: Scleroderma or progressive systemic sclerosis is a systemic connective tissue disease of unknown origin, which normally courses with microangiopathy, extremities ischemia and severe pain. This report aimed at describing a case of intravenous lidocaine to treat ischemic pain and at emphasizing potential anti-inflammatory action of local anesthetics in scleroderma patients. CASE REPORT: Female patient, clear mulatto 34 years old, nursing assistant, with scleroderma for approximately 8 years, presented with severe continuous, daily pain (numeric scale = 10) in upper and lower limbs, followed by trophic, color and temperature changes, and small ulcers on extremities. Patient was submitted to 1 weekly session of intravenous 2% lidocaine (400 mg) without vasoconstrictor for 10 weeks with pain, turgor, skin elasticity and peripheral perfusion improvement. CONCLUSIONS: Pain and other symptoms relief after intravenous lidocaine suggests that local anesthetics are able to modulate inflammatory response in different scleroderma stages.

JUSTIFICATIVA Y OBJETIVOS: La esclerodermia o esclerosis sistémica progresiva es una enfermedad sistémica del tejido conjuntivo, de causa desconocida, que acostumbra acontecer con microangiopatía, isquemia de extremidades y dolor intenso. El objetivo de este relato es describir un caso del empleo de lidocaína por vía venosa en el tratamiento del dolor en el curso de isquemia y dar énfasis a una posible acción antiinflamatoria de los anestésicos locales en los pacientes con esclerodermia. RELATO DE CASO: Paciente del sexo femenino, 34 anos, auxiliar de enfermera, portadora de esclerodermia hace aproximadamente 8 años, presentaba dolor de elevada intensidad (escala numérica =10) en los miembros superiores e inferiores, continua, diaria, acompañada de alteraciones tróficas, de color y de temperatura y pequeñas úlceras en las extremidades. La paciente fue sometida a una sesión semanal de lidocaína a 2% (400 mg) sin vasoconstrictor por vía venosa durante 10 semanas con alivio del dolor, del turgor, de la elasticidad de la piel y de la perfusión periférica. CONCLUSIONES: El alivio del dolor y de otros síntomas después de la administración de lidocaína por vía venosa sugiere que los anestésicos locales pueden modular la respuesta inflamatoria en varios aprendizajes de la esclerodermia.

Implicações clínicas e imunológicas da associação entre o HTLV-1 e a estrongiloidíase / Clinical and immunological consequences of the association between HTLV-1 and strongyloidiasis

A estrongiloidíase é uma das mais importantes helmintíases em países tropicais e estudos epidemiológicos têm demonstrado associaçäo desta parasitose com o vírus HTLV-1. Em regiöes onde estes dois agentes säo endêmicos a coinfecçäo pode resultar no desenvolvimento de formas disseminadas da estrongiloidíase assim como em estrongiloidíase recorrente. Enquanto que o vírus HTLV-1 está relacionado com uma alta produçäo de IFN-gama e desvio da resposta imune para o tipo Th1, a proteçäo contra helmintos está associada a uma resposta Th2. Devido a este viés da resposta imune, indivíduos infectados pelo HTLV-1 apresentam reduçäo na produçäo de IL-4, IL-5, IL-13 e IgE, componentes participantes dos mecanismos de defesa contra S. stercoralis. Estas anormalidades constituem a base para a ocorrência de maior freqüência e de formas mais graves da estrongiloidíase em pacientes infectados pelo HTLV-1